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. 2017 Sep;69(9):1429-1436.
doi: 10.1002/acr.23155.

Dietary and Nondietary Triggers of Oral Ulcer Recurrences in Behçet's Disease

Geoffroy Volle  1 , Jean-Baptiste Fraison  2 , Delphine Gobert  3 , Tiphaine Goulenok  4 , Robin Dhote  5 , Olivier Fain  3 , Solange Gonzalez-Chiappe  1 , François Lhote  6 , Thomas Papo  4 , Aurélie Thuillier  1 , Sophie Rivière  7 , Alfred Mahr  8
Affiliations

Dietary and Nondietary Triggers of Oral Ulcer Recurrences in Behçet's Disease

Geoffroy Volle et al. Arthritis Care Res (Hoboken). 2017 Sep.

Abstract

Objective: The nature and impact of food and other external triggers in recurrences of Behçet's disease (BD)-related oral ulcers (OUs) remain unknown. This survey investigated dietary and nondietary triggers of BD-related OU recurrences.

Methods: Patients with BD who were followed in 7 French hospital departments completed a self-administered patient questionnaire. General and specific dietary triggering factors were sought in open questions. The questionnaire also included closed questions, notably to evaluate the effect of 6 general triggering situations and 24 selected foods. The results were expressed as number (percentage) of positive responses.

Results: Among the 101 questionnaires distributed, 81 were usable. Among the 81 patients, 96% fulfilled the International Criteria for Behçet's Disease classification criteria, and 53% qualified their OU recurrences during the previous 12 months as very discomforting or discomforting. For the 6 general situations suggested, 50 patients (62%) declared ≥1 as a "sure" trigger of OU recurrences. In both open and closed questions, the most frequent triggers were fatigue/stress (37-47% of patients) and food (32-35%). Among the 24 suggested foods, nuts (48%), pineapple (42%), peanuts (32%), Emmental cheese (30%), almonds (23%), lemons (22%), and other cheeses (21%) were the most frequently reported. The corresponding open question gave consistent findings but with lower frequencies.

Conclusion: Most patients can identify triggers of recurring BD-related OUs, with fatigue/stress and food representing the most frequent triggers. The management of OU must consider such external factors. The histamine-rich or -liberating properties of the commonly cited OU-triggering foods suggest a hyperreactivity mechanism.

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